Comparison of porcine xenografts and homografts for pulmonary valve replacement in children Sven Dittrich, MD, Vladimir V Alexi-Meskishvili, MD, PhD,

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Comparison of porcine xenografts and homografts for pulmonary valve replacement in children Sven Dittrich, MD, Vladimir V Alexi-Meskishvili, MD, PhD, Abraham C Yankah, MD, PhD, Ingo Dähnert, MD, Rudolf Meyer, MD, PhD, Roland Hetzer, MD, PhD, Peter E Lange, MD, PhD The Annals of Thoracic Surgery Volume 70, Issue 3, Pages 717-722 (September 2000) DOI: 10.1016/S0003-4975(00)01532-0

Fig 1 Distal xenograft obstruction caused by intimal proliferation. Porcine pulmonary xenograft (diameter 17 mm) explanted 13 months after reconstruction of the right ventricular outflow tract in an 8 kg, 1-year-old girl with double outlet right ventricle and pulmonary stenosis. Cardiac catheterization before reoperation revealed a systolic pressure gradient of 65 mm Hg between the pulmonary artery and the right ventricle. Chest roentgenogram showed no conduit wall calcification. Replacement of the obstructed xenograft was performed using a non-valved polytetrafluoroethylene graft. (A) View from the proximal anastomosis with a clear image of the well-preserved pulmonary leaflets. (B) View on the distal anastomosis, showing a neointimal peel that caused severe obstruction of the conduit (arrows). The Annals of Thoracic Surgery 2000 70, 717-722DOI: (10.1016/S0003-4975(00)01532-0)

Fig 2 Freedom of transcatheter intervention. Absence of graft failure in homograft when compared with xenograft conduits. Indication for transcatheter intervention were valvular or supravalvular transconduit gradients of 50 mm Hg or higher. The Annals of Thoracic Surgery 2000 70, 717-722DOI: (10.1016/S0003-4975(00)01532-0)

Fig 3 Freedom of reoperation. Graft survival of homograft versus xenograft conduits before explantation. Obstruction gradients above 50 mm Hg were considered an indication for conduit exchange if untreatable by transcatheter intervention. The Annals of Thoracic Surgery 2000 70, 717-722DOI: (10.1016/S0003-4975(00)01532-0)

Fig 4 Freedom of valve incompetence > grade 2. Freedom of valve incompetence (insufficiency > grade II as estimated by color flow mapping) was 65% after 3 years in the homograft group. Xenograft valve function does not differ from homograft valve function within a 2-year follow-up period. The Annals of Thoracic Surgery 2000 70, 717-722DOI: (10.1016/S0003-4975(00)01532-0)

Fig 5 Histology of an explanted xenograft. (A) Histological changes in a porcine pulmonary xenograft 13 months after implantation in a 1-year-old patient. The valve tissue appeared intact. In the distal area of the medial layer of the pulmonary artery wall, there is fibrous transformation with loss of elastic membranes. In these areas, the actin filaments have vanished and been replaced by connective tissue scars. (B, C) Larger magnifications. Areas with scar tissue consisted of a small number of preexistent smooth muscle cells, single macrophages, and fibroblasts. The supravalvular tissue proliferation creates an obstruction of the vessel lumen through plaques coated with intact and activated endothelium. The Annals of Thoracic Surgery 2000 70, 717-722DOI: (10.1016/S0003-4975(00)01532-0)